Do you wake at night to smoke?

Two papers published this month highlight the fact that a surprising number of smokers wake at night to smoke, and suggest that this is a sign of nicotine addiction.

A paper published in the International Journal of Clinical Practice by Michelle Bover and colleagues at UMDNJ-School of Public Health, found that of over 2,300 cigarette smokers seeking treatment at our Tobacco Dependence Clinic, 51% said that they sometimes wake at night to smoke. Those who sometimes do this were significantly less likely to succeed in quitting smoking (at 6 month follow-up), and relapsed earlier, even after controlling for a bunch of other variables that are predictive of treatment outcome. Interestingly, in this study, night smoking was a better predictor of relapse than the usual measures of dependence: number of cigarettes smoked per day, and time to first cigarette of the day.

Another study by Deborah Scharf and colleagues at University of Pittsburgh (published in "Nicotine & Tobacco Research") measured night smoking using an electronic palm-pilot diary during 2 weeks prior to a quit attempt. They found that a single question about night smoking at baseline correlated well with the electronic diary measures of night smoking and that night smoking was associated with greater nicotine dependence, caffeine consumption, and lapse to smoking within the first 28 days. In this study 41% of participants smoked at night.

So both of these quite different studies yielded remarkably similar results. They suggest that clinicians should start to ask their patients about night smoking as a way to assess nicotine dependence. The two questions we feel are most helpful are:

1. Do you sometimes awaken at night to have a cigarette or use tobacco? (yes/no)
2. If yes, how many nights per week do you typically awaken to smoke?

If you are a smoker who wakens at night to smoke, at least once per week, this may be a sign that you are highly addicted to tobacco. When you are trying to quit smoking it may be worth considering this factor in your quit attempt. You may want to tackle other factors (e.g. caffeine intake) that may disrupt your sleep, you may want to avoid smoking cessation medications known to disrupt sleep (e.g. Zyban) and you may want to consider whether the 24-hour nicotine patch may be helpful for your night cravings. There is insufficient data at the moment to give clear guidance on the implications of night smoking, but these two papers suggest that people who wake at night to smoke will find it harder to quit, and so may need more intensive treatment (counseling support and pharmacotherapy).

If you are a smoker who wakes at night to smoke, I'd be interested in hearing more about it. Does it seem as though you wake up wanting a cigarette, or do you just wake up and smoke for something to do? Do you also get up and eat some food for something to do?

You can find full pdf and HTML versions of the Bover et al paper at:
http://www.tobaccoprogram.org/staffarticles.htm

You can obtain copies of a tobacco assessment questionnaire that includes the two questions mentioned above, at:
http://www.tobaccoprogram.org/questionnaires.htm

Labels: jonathan foulds, night smoking, smoking cessation

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